![\"NEW](\"https:\/\/i-base.info\/htb\/wp-content\/uploads\/2017\/02\/NEW-CROI-LOGO-2017-241x300.png\"){kind=logo}
<\/p>\n<\/p>\n
Richard Jefferys, TAG<\/strong><\/p>\n Several important TB studies were presented as late breaker oral presentations at CROI 2017, on treatment for extensively drug-resistant TB (XDR-TB) and on TB-IRIS.<\/strong><\/p>\n Highly promising results from the Nix-TB study were presented by Francesca Conradie of the University of the Witwatersrand in Johannesburg, on a breakthrough in treating XDR-TB, a condition normally requiring the use of debilitating, toxic injectable drugs. [1]<\/p>\n This small study uses a new combination of three oral drugs (bedaquiline, pretomanid, and linezolid). Of the 72 participants (39 men and 33 women) enrolled so far, 31\/72 have reached the primary endpoint of being culture negative after 6 months follow-up. Of these, only two cases of relapse\/reinfection were reported (still to be determined, but suspected reinfections), and only one case with XDR-TB. However, four participants died, all within the first eight weeks: 3\/4 due to multi-organ TB (on autopsy) and 1 due to gastrointestinal bleed relating to erosive oesophagitis.<\/p>\n Tolerability was good with most side effects (peripheral neuropathy and myelosuppression relating to linezolid) being manageable, even with short dose interruptions.<\/p>\n This greatly shortened all-oral combination therefore provided extremely encouraging results both for safety and efficacy.<\/p>\n A short report by Jon Cohen in Science, included a comment that the combination would have likely efficacy for MDR-TB, whether Nix-TB data would be sufficient for pretomanid to become approved and the issues of cost and access. [2]<\/p>\n Immune reconstitution inflammatory syndrome (IRIS) is a potentially life-threatening consequence of the restoration of immune responses to opportunistic pathogens in people who initiate ART at low CD4 T cell counts.<\/p>\n Evidence suggests that immune responses can become exaggerated and overly inflammatory as a deficient, dysregulated immune system begins to recover due to ART-mediated HIV suppression. In some cases opportunistic infections can get worse before improving, a problem termed paradoxical IRIS. This is a particularly significant concern in tuberculosis (TB), with a reported mortality rate of around 3%. [3]<\/p>\n In an effort to reduce morbidity and mortality from paradoxical TB-IRIS, Graeme Meintjes and colleagues conducted a randomised trial evaluating a four-week course of the corticosteroid prednisone in individuals at risk. The encouraging results were debuted as a late-breaker at CROI, with Meintjes reporting a significant 30% reduction in the incidence of paradoxical TB-IRIS and a trend toward decreased hospitalisations in the prednisone arm. [4]<\/p>\n No evidence of an increase in cancer risk – which had been raised as a potential issue with prednisone – was observed. The evidence from the trial suggests that the approach should be adopted as the standard of care for individuals at risk for paradoxical TB-IRIS.<\/p>\n References:<\/p>\n Richard Jefferys, TAG Several important TB studies were presented as late breaker oral presentations at CROI 2017, on treatment for extensively drug-resistant TB (XDR-TB) and on TB-IRIS. Highly promising results from the Nix-TB study were presented by Francesca Conradie of …<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,31,37],"tags":[236],"class_list":["post-31488","post","type-post","status-publish","format-standard","hentry","category-conference-reports","category-opportunistic-infections-coinfections-and-complications","category-tb-coinfection","tag-croi-2017"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/31488","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=31488"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/31488\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=31488"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=31488"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=31488"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}\n
\nhttp:\/\/www.croiconference.org\/sessions\/nix-tb-trial-pretomanid-bedaquiline-and-linezolid-treat-xdr-tb<\/a>\u00a0(abstract)
\nhttp:\/\/www.croiwebcasts.org\/console\/player\/33483<\/a>\u00a0(webcast)<\/li>\n
\nhttp:\/\/www.sciencemag.org\/news\/2017\/02\/simpler-safer-treatment-hailed-breakthrough-against-drug-resistant-tb<\/a><\/li>\n
\nhttp:\/\/www.clinicaltuberculosisjournal.com\/article\/S2405-5794(15)30009-7\/fulltext<\/a><\/li>\n
\nhttp:\/\/www.croiconference.org\/sessions\/randomized-controlled-trial-prednisone-prevention-paradoxical-tb-iris<\/a>\u00a0(abstract)
\nhttp:\/\/www.croiwebcasts.org\/console\/player\/33484<\/a>\u00a0(webcast)<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"